ELECTRONIC HEALTH RECORD U–TURN: ARE VA AND DOD HEADED IN THE WRONG DIRECTION? HEARING BEFORE THE COMMITTEE ON VETERANS’ AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED THIRTEENTH CONGRESS FIRST SESSION WEDNESDAY, FEBRUARY 27, 2013 Serial No. 113–6 Printed for the use of the Committee on Veterans’ Affairs ( U.S. GOVERNMENT PRINTING OFFICE 79–941 WASHINGTON : 2013 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Aug 31 2005 13:49 Nov 25, 2013 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 Y:\113THC~1\FC\2-27-13\GPO\79941.TXT LEN VACREP180 with DISTILLER COMMITTEE ON VETERANS’ AFFAIRS JEFF MILLER, Florida, Chairman DOUG LAMBORN, Colorado MICHAEL H. MICHAUD, Maine, Ranking GUS M. BILIRAKIS, Florida CORRINE BROWN, Florida DAVID P. ROE, Tennessee MARK TAKANO, California BILL FLORES, Texas JULIA BROWNLEY, California JEFF DENHAM, California DINA TITUS, Nevada JON RUNYAN, New Jersey ANN KIRKPATRICK, Arizona DAN BENISHEK, Michigan RAUL RUIZ, California TIM HUELSKAMP, Kansas GLORIA NEGRETE MCLEOD, California MARK E. AMODEI, Nevada ANN M. KUSTER, New Hampshire MIKE COFFMAN, Colorado BETO O’ROURKE, Texas BRAD R. WENSTRUP, Ohio TIMOTHY J. WALZ, Minnesota PAUL COOK, California JACKIE WALORSKI, Indiana HELEN W. TOLAR, Staff Director and Chief Counsel Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans’ Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occur- rences are inherent in the current publication process and should diminish as the process is further refined. ii VerDate Aug 31 2005 13:49 Nov 25, 2013 Jkt 000000 PO 00000 Frm 00002 Fmt 0486 Sfmt 0486 Y:\113THC~1\FC\2-27-13\GPO\79941.TXT LEN VACREP180 with DISTILLER C O N T E N T S February 27, 2013 Page Electronic Health Record U–Turn: Are VA and DoD Headed In The Wrong Direction? .............................................................................................................. 1 OPENING STATEMENTS Hon. Jeff Miller, Chairman, Full Committee ........................................................ 1 Prepared Statement of Chairman Miller ........................................................ 34 Hon. Michael Michaud, Ranking Minority Member, Full Committee ................. 2 Prepared Statement of Hon. Michaud ............................................................ 35 WITNESSES Hon. Roger W. Baker, Assistant Secretary for Information and Technology and Chief Information Officer, U.S. Department of Veterans Affairs ............. 4 Prepared Statement of Mr. Baker and Dr. Petzel ......................................... 36 Accompanied by: Hon. Robert A. Petzel, M.D., Under Secretary for Health, Veterans Health Administration, U.S. Department of Veterans Affairs Hon. Jonathan A. Woodson, Assistant Secretary of Defense for Health Affairs, Director, TRICARE Management Activity, U.S. Department of Defense ....... 6 Prepared Statement of Mr. Woodson and Hon. Elizabeth McGrath ............ 38 Accompanied by: Hon. Elizabeth A. McGrath, Deputy Chief Management Officer, U.S. Department of Defense Valerie C. Melvin, Director, Information Management and Technology Re- sources Issues, U.S. Government Accountability Office ................................... 7 Prepared Statement of Ms. Melvin ................................................................. 40 Jacob Gadd, Deputy Director for Health Care, The American Legion ................ 9 Prepared Statement of Mr. Gadd .................................................................... 49 Executive Summary of Mr. Gadd .................................................................... 51 QUESTIONS FOR THE RECORD Letter and Questions From: Hon. Jeff Miller, Chairman, To: Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans Affairs .............................. 51 Responses From: Department of Veterans Affairs, To: Hon. Jeff Miller, Chair- man ........................................................................................................................ 53 Letter and Questions From: Hon. Michael Michaud, Ranking Minority Mem- ber, To: Hon. Chuck Hagel, Secretary of Defense ............................................. 57 Question #1 From: Hon. Michael Michaud, Ranking Minority Member, To: DCMO McGrath ................................................................................................... 58 Question #2 From: Hon. Michael Michaud, Ranking Minority Member, To: DCMO McGrath ................................................................................................... 58 Question #3 From: Hon. Michael Michaud, Ranking Minority Member, To: DCMO McGrath ................................................................................................... 59 Question #4 From: Hon. Michael Michaud, Ranking Minority Member, To: DCMO McGrath ................................................................................................... 62 Question #5 From: Hon. Beto O’Rourke, To: Hon. Jonathan A. Woodson .......... 62 Question #6 From: Hon. Beto O’Rourke, To: Hon. Jonathan A. Woodson .......... 63 Question #7 From: Hon. Beto O’Rourke, To: Hon. Jonathan A. Woodson .......... 63 Question #8 From: Hon. Beto O’Rourke, To: Hon. Jonathan A. Woodson .......... 64 Question #9 From: Hon. Beto O’Rourke, To: Hon. Jonathan A. Woodson .......... 64 Question #10 From: Hon. Beto O’Rourke, To: Hon. Jonathan A. Woodson ........ 65 Letter From: Hon. Michael Michaud, Ranking Minority Member, To: Hon. Gene L. Dodaro, Comptroller General of the United States, Government Accountability Office ............................................................................................ 65 iii VerDate Aug 31 2005 13:49 Nov 25, 2013 Jkt 000000 PO 00000 Frm 00003 Fmt 0486 Sfmt 0486 Y:\113THC~1\FC\2-27-13\GPO\79941.TXT LEN VACREP180 with DISTILLER Page Question From: Hon. Beto O’Rourke, To: Ms. Valerie C. Melvin, Director, Information Management and Technology Resources Issues, U.S. Govern- ment Accountability Office .................................................................................. 65 Letter and Response From: Ms. Valerie C. Melvin, Director, Information Management and Technology Resources Issues, U.S. Government Account- ability Office, To: Hon. Michael Michaud, Ranking Minority Member ........... 65 iv VerDate Aug 31 2005 13:49 Nov 25, 2013 Jkt 000000 PO 00000 Frm 00004 Fmt 0486 Sfmt 0486 Y:\113THC~1\FC\2-27-13\GPO\79941.TXT LEN VACREP180 with DISTILLER ELECTRONIC HEALTH RECORD U–TURN: ARE VA AND DOD HEADED IN THE WRONG DI- RECTION? Wednesday, February 27, 2013 U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS’ AFFAIRS, Washington, D.C. The Committee met, pursuant to notice, at 9:15 a.m., in Room 334, Cannon House Office Building, Hon. Jeff Miller [Chairman of the Committee] presiding. Present: Representatives Miller, Lamborn, Roe, Denham, Run- yan, Huelskamp, Coffman, Wenstrup, Cook, Walorski, Michaud, Takano, Brownley, Kirkpatrick, McLeod, Kuster, O’Rourke, Walz. OPENING STATEMENT OF CHAIRMAN MILLER The CHAIRMAN. The Committee will come to order. I want to thank everybody for being with us this morning to our hearing entitled Electronic Health Record U–Turn: Are VA and DoD Headed in the Wrong Direction? Today’s hearing is prompted by the recent announcement by the Departments of Defense and Veterans Affairs that they would no longer be developing a single integrated electronic health record or IEHR. The announcement earlier this month was surprising to this Committee and Congress given the number of previous statements that the health record was coming along as planned even on an ac- celerated timeline. And the other surprise about VA and DoD’s announcement was that this Committee heard about this the very first time by pub- lished news reports. While it is not the first time this has happened, it is equally dis- appointing given the number of times that this Committee has pledged to work with both departments in support of making the electronic record a reality. Now, in late 2010, both departments co-announced an integrated electronic health record as a single solution to our common require- ments. In June 2012, the two departments set an expected timeline of a 2017 rollout for that record. In July of 2012, both secretaries testified before this Committee and the Armed Services Committee that reinforcing a single inte- grated record was the way forward and that their respective de- partments would achieve that goal together. This past December, it was stated that VA and DoD could roll out the health record even faster without much supporting detail. (1) VerDate Aug 31 2005 13:49 Nov 25, 2013 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 Y:\113THC~1\FC\2-27-13\GPO\79941.TXT LEN VACREP180 with DISTILLER 2 The latest news, a mere two months later, has us asking again whether even the original 2017 timeline is a realistic timeline. The end project, will it deliver the same level of integration for transitioning servicemembers? Interoperable is not the same as in- tegrated. While I understand that information can still be shared, VA and DoD have to explain to this Committee, to this